The profession of massage therapy has changed dramatically since I got my license in 1994. After finishing school, you’d get your feet wet working at a spa or chiropractic office for a year or so to gain some experience. Eventually, you’d build up a clientele and go into practice for yourself or expand into another more lucrative scenario. Outside of large luxury hotel spas, it was mostly mom-and-pop style practices. The market was straight forward. Entry level work paid relatively well. The economy was solid. It was the Clinton years.

Having a thriving word-of-mouth business was an attainable goal for any MT worth their salt. It still is, but the playing field has changed dramatically with the momentum of technology and a widening market. The growing massage industry is an awesome thing. It’s creating more jobs with more variety and is a sure sign people are making massage therapy part of their lifestyle. It’s feel-good healthcare everyone deserves access to.

Booming demand, little supply

In a 2015 article (recent enough), MSN Money referenced massage therapy as #5 on a list of the 10 fastest growing jobs in the US. There is clearly more demand for massage than ever. If so, why does our profession continue shrinking at an alarming rate? Consumption of our services is on the rise, yet there is a smaller pool of talent to choose from. That may mean more opportunity for the rest of us, but we can’t possibly fulfill all the supply for the increasing demand. We need more hands on deck!

Before I continue, Alice Sanvito makes excellent statistical references to what I am addressing in her Facebook note: Massage Therapy: A Profession in Crisis?(It includes an insightful and thought provoking public discussion. I encourage you to check it out. It echoes all of the realities discussed in this blog post and is what prodded me to write it). Alice writes:

The statistics look grim: nationwide, 25% of massage schools have closed in the last 10 years and there has been a 50% drop in the number of students graduating from massage therapy programs during that same period of time. Spas and franchises say they are turning clients away because they are understaffed.”

A veteran’s view

Though many of us dinosaurs still practice, we also like doing other things like evolving our practices, teaching, and/or developing continuing education websites cough-coughPinpointBodyworkcough. We still enjoy learning and building upon our work every chance we get. Personal improvement is an essential part of being a pro, no matter what you do.

With all of these cool new industry developments in place, we are still left with the problem of a shrinking workforce and I’m not exactly surprised. Massage therapy as a career choice is not like it was back in my day. But it should be and can be even better. There’s no excuse. A big part of this deficit has rampant worker and wage misclassification at its root.

Employer misclassification of their employees as independent contractors is a widespread phenomenon in the United States. The IRS estimates that employers have misclassified millions of workers nationally as independent contractors. While some employers misclassify their workers as independent contractors in error, often employers misclassify their employees intentionally in order to reduce labor costs and avoid paying state and federal taxes.” –Department for Professional Employees AFL-CIO 2016 Factsheet

Wake up call

Newer MTs are being taken advantage of because they don’t understand their rights. They’ve resigned them to a false status quo and borderline illegal practices disguised as normal business procedures. If you find yourself in any of the situations described this article, it is important to speak up bravely when you feel ready. You deserve to love your work.

It takes only a handful to start the ball rolling in the right direction. I understand we are kind and giving people by nature who generally prefer to avoid confrontation, but you can and should demand fairness. Sometimes a risky confrontation is necessary to underline your worth. I’m here to straighten up the facts and hopefully encourage the next generation to stand up for themselves. Knowledge is power and there is strength in numbers.

The crossroads of the future of massage

I want to highlight the positive aspects first. Running a business from the top-down-to-the-bottom is not all rainbows and puppies. The following 3 scenarios offer MTs the opportunity to be self-employed as independent contractors without having to worry about the headaches of actually running a business:

Outcall massages are no longer considered a luxury reserved for the wealthy. At almost anytime of day, a client can instantly have an affordable in-home massage. They just press a button on an app. No need to go back and forth about scheduling. No need for cash. All of their payment and location information is securely stored.

Mobile chair massage is huge. Corporations are making in-office massage therapy a major star in their employee perks packages.

And in case no one noticed, massage franchises keep popping up everywhere. More people have access to massage therapy through affordable rates and membership fees. Some business hire MTs as employees but fill in the gaps with independent contractors, especially if there isn’t a budget to consistently pay employees during slower times.

These are winning set-ups for MTs, the business who hire them, and the clients. An IC has the freedom to work as they choose. A company contacts them on a client’s behalf to provide a service. The IC can decide whether they want to work with them. The IC performs the service and the company handles everything else. Everyone earns their cut. It’s convenient and a very cool implementation of technology.

The big plusses

As an independent contractor, the responsibilities of meeting overhead costs, record keeping, billing, collections, laundry, marketing, client retention, all sit on someone else’s shoulders. MTs just agree to show up to any gig they choose for a pre-set amount of time. They get paid for a job well done and are free to do whatever else with their time. There is variety. They can see private clients, spend time with family, pursue other interests, have another part-time job, or read a novel in the park until the next call for work comes through. Few fields offer this kind of flexibility.

This means MTs with entrepreneurial spirits who may not have the strongest business sense can still be independently successful by partnering with companies who hire massage therapists as independent contractors. On the other hand, business minded people who may not exactly have the background or desire to offer actual physical massages can contribute to the workforce by handling the hands-off details. Everyone does what they do best. Everyone wins.

The perks of being a W2 employee (not IC) are predictable schedules, salary, and paystub management. There is great freedom in not having to go out and hustle for your next buck. There is security in knowing you will be getting paid whether it’s busy or slow. As an employee you are compensated for fulfilling certain job requirements and representing a business brand. There are clear mutual expectations in this working relationship.

Here’s where it began to go wrong

In the first paragraph of this post, I made reference to how good things were for us circa 1990s-2000something. We had a minimum standard of wages and it was good. Enter the economic recession of 2007.

Once the recession hit, people no longer had the expendable income to budget for non-vital care like massage. There were job layoffs and other life uncertainties. Business were closing shop. Wages were cut while inflation soared. Priorities had to shift. There was a major temporary change in our overall economy. Up next is what happened with the massage profession as a result of the recession.

Tipping as wages

One way massage establishments were able to stay in business was by doing something very clever: they kept wages low while encouraging a tipping culture similar to what is done in the restaurant industry. They could shell out less money for skilled labor and subsidize MT employment costs by encouraging customers to leave gratuity instead of paying full wages.

You started seeing franchise advertisements for $45 massages. This was a great for introducing more people to massage and getting a greater volume of clients through the door. But somewhere along the line someone started getting shafted.

Once upon a time, a therapist could earn a fair percentage for their services. After the recession, the market standard rate for massage services dropped out of survivalist necessity. However, many wages didn’t recalibrate when the US economy started to improve again. Therapists continue to make as low as $12-15/hr base wage in some places.

If a client tips $10, that comes out to $25/hr which isn’t bad. But if you consider inflation since the mid-90s and tuition fees it isn’t great either. Remember, this is if a client tips. That amount doesn’t stretch at all if you’re located where I am in New York City or anywhere with a high cost of living. MTs pay good money for education and accrue student loans to earn their credentials. More importantly, tips should not be appointed in place of fair wages.

The truth is clients do not always know to tip and should not have to. This is technically healthcare service. When was the last time you tipped your physical therapist, nurse, or dentist? We’re lucky it isn’t considered a weird taboo for clients to tip sometimes, but we should never need to rely on them to pay the bills. Sadly, that’s not the case right now and MTs are growing more and more bitter about this situation. Less and less people are wanting to join the workforce as MTs because of these exact pay scale horror stories. Many have opted to drop out because it’s not a sustainable income model over time. Let’s not mince words: the wages in a tip-reliant scenario can feel like they suck in some set-ups. But as you will see, you indeed have choices.

The recession has been officially over since 2009

There may have been a recession but we are not in one anymore. Yet many businesses did not resume paying employees a living wage since it was officially declared over. They already programmed MTs to jump through tipping hoops to round out their income. If therapists aren’t demanding better for their time and talents, why should an employer bother paying them accordingly? Let them misdirect the financial supplementation onto the customer. The tipping culture in MT has become a win-lose situation and employers are not the ones losing. They are cashing in on a good economy and the booming massage industry while employees keep settling for less. Why?

No wonder there’s a fleet of disgruntled MTs who lose passion within a couple years. Business models like these leave them short changed and deflated. Then they warn others against this profession because of their negative experience. No one enjoys feeling undervalued with a heap of loans to pay off. These types of business don’t care and will just replace any MT with the next new clueless graduate desperate for work and experience. Don’t be one of them. Realize there are many MTs doing well right now and benefitting from the current boom. Those are the ones who practice practice practice and stand up. Those are the ones who choose environments where they feel appreciated.

NEWSFLASH: this should not be the norm

Yes, we all have to start somewhere but wherever that somewhere is, make sure you are respected and paid a decent wage to start. I started off at $10/hr way back then, but I considered access to a gym and a lovely outdoor premises to be perks (they were at the time). A massage business is nothing without its massage therapists keeping clients happy and returning for more. Remember that. This is a people business and you are a major player.

Tips are nice, but should never be expected in this line of work. They should especially not be used to subsidize wages that are part of employment. We are health service professionals. It’s not your client’s fault if they do not tip because they should not have to. Tips are not guaranteed wages, but somehow newer MTs are being duped into believing so. Demand better wages commensurate with your experience, just like every other job or welcome to the burnout mill.

For the record, not all establishments are like this. Most are wonderful and set great examples by creating healthy jobs. I’m not talking about those. You know who you are.

Independent contractors

We just spoke about being an employee, which greatly differs from being an independent contractor. The IRS clearly outlines the differences between the two here. These definitions aren’t just ideological verbal distinctions. Blurring the lines between the two is actually in violation of tax law and business can be penalized and ordered to pay back taxes for misclassifying their workers.

Would you believe it if I told you an overwhelming number of massage business blur these lines to keep their costs low and keep a tight lock on your independence as an IC? Most MTs don’t even realize how they are being undermined as self-employed professionals. The controls certain companies will attempt to place on you as an IC technically qualifies you as an employee in the eyes of the IRS, which means they better be covering your taxes! And if not, they may be liable to back pay them for you. This is important for you to know. You have choices and leverage.

This is what an employee is

Under common-law rules, anyone who performs services for you is your employee if you can control what will be done and how it will be done. This is so even when you give the employee freedom of action. What matters is that you have the right to control the details of how the services are performed.”–The IRS

For example, let’s say a company chooses to work with you as an IC for an onsite chair massage event. In this scenario:

You are likely expected to bring your own supplies which you have paid for as a self-employed MT, but they cannot tell you which brand you must use (unless they supply it and you are only providing your manual skill).

You are responsible for arriving prepared and on time and providing the service to the client, of course. However, it is technically the company’s client. They rightfully earn their cut for getting you work and arranging the whole thing, and you get yours for providing good service. Cool. But they cannot tell you how to do your job, rather they choose to hire you because they like and trust the work you already do. You are not required to change a thing and they are not required to hire you in particular again.

You are paid for each gig as it is completed. You represent the hiring company for a prearranged amount of time and respect boundaries, but you are still your own business entity because you are paying your own taxes and/or using your own supplies. That is where the business transaction ends. Win-win. You don’t have to deal with the hassle of scheduling, advertising, and paperwork and they have good faith in your representation and talent. Teamwork!

Real life scenario

Now, let’s say one of the individuals you are working on at the aforementioned event really loves your technique and wants your information to schedule a 1-hour massage. No matter what the hiring company says, you are 100% allowed to give them your card directly! I know many try to forbid this, but they can’t because you are not their employee. You are an IC and you are not directly competing with the service you were hired for.

An onsite chair massage is apples and oranges to 1-hour private massages. As long as you are paying your own taxes, you are allowed to reap the reward for being a talented self-employed professional. But you are not allowed to try to steal the corporate client or directly solicit individuals. That is bad tacky karma, so please respect the boundaries of your hiring company. Just be sure they understand your rights as a self-employed professional. You may need to remind them.

The art of misclassification

But my company said I need to go through them first before accepting a private client.

No. No you don’t. And I assure you that will never happen. A potential client isn’t going to play the HR middleman game just so they can be granted your info. Life gets busy and people forget. Who is anyone kidding?! We are an instant gratification society. You earned that opportunity and have every right to it without needing a babysitter’s permission. There is nothing wrong here except for a company blocking your ability to thrive outside of that gig. You are self-employed. Remember that.

If your IC hiring company is trying to control whether you can give your business card to an individual who requests it for a different service, they have just blurred the tax line. This is only allowable if you are their employee. In that case, you must be payed a consistent salary and they need to be reporting your wages as such on the proper tax forms. The IRS does not take kindly to this and neither should you. Uber keeps getting sued and is in hot water for this exact type of misclassification.

Guess what else you don’t have to do? Show up to “mandatory” meetings. As an employee, your time must be paid for at mandatory meetings. As an IC, if you are required to show up for a meeting outside of any service you provide, you are entitled to a stipend for your time and should ask for one. Pass the information on.

But I already signed a contract!

Consider this a reminder to read contracts thoroughly before signing them. (An upcoming article will be about the bogus jurisdiction of non-compete agreements and how the stipulations have gotten ridiculously out of control. Spoiler alert: do not sign one.) You have the right to add an addendum to any contract. Even if you did sign a contract, however, the law might be above it according to what the New York State Department of Labor says here:

Even if your employer hired you to work as an independent contractor, the law may still consider you an employee. This means you may qualify for unemployment insurance (UI) benefits… Employees also may get certain fringe benefits. For example: an allowance or repayment for business or travel expenses.” -NYSDL

Obvious disclaimer: I’m not an attorney.

You better run all of the above by a lawyer in your area. I’m just a tiny dancer trying to stir up trouble for anyone taking advantage of MTs. Remember there is an MT shortage, not surplus so I suggest ya’ll get on top of the game. You have an upper hand, so stand up for yourself. This is my PSA for the next generation.

Beware the shady MT

I believe there are more symbiotic A+ employers than there are ones in the scenarios described above. However, there are enough to merit addressing this issue. There may be some shady businesses, but we all know there are shady therapists, too. You know who I’m talkin’ ’bout. Employers are not immune to getting burned.

The shady MT is the one who goes into a job attempting to steal clients from their employer. They’re the ones who ride the coattails of the employer doing all the hard work to get clients through the door. But this rarely works because successful businesses are about successful relationships. The shady MT ruins the party by making potential employers paranoid about every MT’s motives. It’s a small world and if shady MT thinks they are going to make it this way, they are wrong. Word travels fast and that’s the kind of ship that sinks.

Dear MT employers,

Look. I understand you try keeping tight controls on your independent contractors to deter shady MTs, but the shady MT is going to try and run a crooked game whether you have rules in place or not. That’s because they just rude and shady. The overwhelming majority of MTs are honorable and hard working and you should not let a bad apple spoil the bunch. There is no need to treat well-trained independent professionals like chattel.

If an MT does a great job for you and someone wants to hire them for a different service, let them thrive! They are not your property and you ain’t paying their taxes or living expenses. Don’t worry, karma gets shady MT in the end. It’s about team trust.

There are risks we all take in business. But acknowledge the people who represent your company well. Or pay their taxes…. geez, sumthin… Really, how many clients do you think are actually going to be satisfied with the ethical low of a shady MT? Most will report the shadiness to you when there is a good professional relationship (I would assume there is, and if there isn’t perhaps that is something you may want to work on). Chill.

The truth is, you want to hire good therapists. Duh. A client may become loyal to them because they truly helped them in some way. Occasionally one of these therapists will want to expand. Almost always, they’ve been excellent employees and aren’t shady MTs. What are you gonna do? You can’t exactly prevent clients from wanting them (and umm, there’s Google).

Here’s what you can do without be an unrealistic curmudgeon or resorting to legal silliness that likely won’t hold up in court: offer them a raise, reward them with lunch on Fridays, movie passes, or a paid day off. Sponsor a CE class. Offer to rent them a room as an IC at your location. Maybe open another location and put them in charge. Pay for a gym membership or hold a weekly yoga class for employees. Happy employees tend to stay where they feel valued and respected. Wouldn’t you?

Eventually, they may decide to go elsewhere, but you can’t control that. It’s just life and you will continue to have great employees when you are a good employer. Most clients will remain loyal to your business because they like your vibe and the personalities you attract there. But sometimes you must let your babies go 🙂

Dear employers, it would be a good idea to temper the control-freak practices. They are highly responsible for disillusioning some really good therapists and burning them out. Without therapists, your business wouldn’t be in business, so chill with placing bogus permissions on grown professionals. MTs are noticing when wages don’t feel right in accordance with expectations and as a result our population is thinning. No one wins in that scenario. Not even you.

Dear MTs,

You cannot fault a business owner for wanting to both save money and earn more profits (there is a difference between that and being stingy). If you are not happy in your work situation, it is your responsibility to grow a pair and speak up, and yes that involves risk or you can’t exactly complain. You cansucceed on your own in a variety of ways. That’s what is so great about this work. You have a win-zone. Not everyone knows the law, but now that you know you can pass the info along. There is strength in numbers.

And by large numbers everyone needs to be bringing their professional A-game to the table. MTs can’t be showing up misinformed and whiney with bad attitudes, and hope to motivate employers to invest in them. This is not that kind of work. If you expect everything on a platter, you will be disappointed. We earn our stripes. This is a unique manual art and you better enjoy it, otherwise it ain’t workin out. We must bring our personal best to expect equal renumeration for it.

It’s important to understand what employers put into running a business in order to provide steady work opportunities. They invest a lot of resources while dealing with the after-hours headaches. Appreciate this partnership and don’t burn bridges. Employers work every bit as hard as you do. It’s a two-way street.

Most of us love our work and do the right thing (preaching to the choir). That’s not who I’m talking about. You know who you are.

The future is good

It is an exciting time to be a massage therapist. Those of you stepping into the workforce now have more opportunity and validity then ever. Massage therapists were and still are a valuable commodity. There is an explosion of variety and you can earn your living in many ways, or change up your approach at anytime.

We have user-friendly technology at our fingertips that makes it possible to run an entire business on a smartphone. There is an increasing demand for our services and we have an important role to fill in healthcare. Know your rights and know your worth. Please share this article with anyone you think may benefit from it… perhaps even your employer 😉

Massage therapy has become a battle ground for modalities. Some claim to be new and others are considered more traditional. There are clever hybrids and tribrids of the different schools in between. The truth is, touch and manual therapy have been around since the evolution of hands and there’s not much new under the sun regarding what we do with them. It’s all been done and touch will continue to be applied under all kinds of labels. It’s fun to get creative with our hands as therapeutic tools and call it marketable stuff. Please let me know in the comment section if you’ve encountered the modality church phenomenon described below!

What makes a massage a modality?

I like to think of massage therapy as music (perhaps because I’m a musician, but painting, sculpting, engineering, and other analogies work just as well). As we know, music is comprised of basic beats/rhythms, notes/tonalities, and spaces in between called rests. Certain combinations of beats and notes get categorized as different genres, or in our case, modalities. There is classical music, world music, metal, punk, free jazz, bebop, etc. Bodywork modalities are just as nuanced and varied.

We use methods from the East and West, both mysterious and medical. Ancient and modern. Experimental and clinical. There are almost as many theories as there are modalities, but touch is touch. Music is music. What matters is an understanding of the researched fundamentals to make it functional. Everything else is personal preference, still under investigation, or completely made-up.

Certification, shmertification

Diversity in practice is a wonderful characteristic of our profession. No one modality is better or worse than another. They can all be effective. They can all fall short. Positive outcomes are based on the following:

establishing a trustworthy therapeutic relationship

client beliefs and expectations

understanding the principles of physiology and touch

understanding the best applications of your particular “toolkit” (the how-and-when-to-use-or-not-use your choice of techniques)

perhaps, a little luck

These understandings can be intuitive or cerebral, however, a good clinical outcome has nothing to do with a certification in one thing vs. zero certifications in anything. Certifications are a nice touch to hang on the wall and indeed note an accomplishment, but they are not to be credited as a justification for results. Not in this line of work. For what it’s worth, I’ve gotten fantastic results from many uncertified novices who have no ego about it. And I’ve come out unaffected and sometimes worse at the hands of professionals who flash credentials like a badge of authority. Certifications are not exclusive qualifiers nor can they guarantee results.

Anatomy of a Modality

In every modality fundamental concepts are at play the moment we put our hands on somebody. It doesn’t matter if I’m performing Shiatsu or Swedish. Nerves light up when they are pressed or stroked, with or without lubricant. The sensations and combinations of tactile stimuli may translate differently in the brain, but pressure is pressure, stretch is stretch, warmth is warmth, traction is traction, and vibration is vibration.

There are also reflexes in the body we can learn to use to our advantage as we develop our sensitivity; like reciprocal inhibition, the crossed-extensor reflex, myotatic and tendon reflexes. Lastly, we can wrap all of the above in layers of neuroscience, psychology, and consciousness to make for a very rich palette of techniques with theoretical complexities. You can throw in toys like foam rollers, cupping, and IASTM (not an endorsement for any, just examples), still, the basic concepts are what hold up.

Different instructors will select certain basic bodywork elements and combine them in ways they have found to be effective. But guess what? All touch can be effective when applied appropriately and with genuine care. In all hands-on CE classes, you’re basically learning a different take on touch. This is a fantastic way to freshen our practice and pick up other ideas. It is invaluable to discover alternate ways of approaching the body. Learning cool moves, old and new, keeps us fresh, curious, and excited about our work.

Plot twist

What happens when an instructor patents their preferred approach under the guise of “proprietary information”? I chuckle, lol. You can’t exactly patent or trademark touch, silly goose. However, this flavor of instructor-with-guru-complex often succeeds in creating what Paul Ingraham calls a modality empire. (Thanks for calling it what it actually is, Paul!) It is merely clever marketing of recycled manual interventions. The ™ symbol is added to aid in amassing a church of followers who will spread the gospel for their guru (as if their certification will spare them from ever having to exercise critical thinking in practice).

I am going to call this type of institution a modality church instead, because the dogmas often borderline on religious fanaticism. The majority of these dogmas have been systematically disproven or remain completely unproven. I’m not sure which is worse, but I’ll bet you $50 a modality church guru will throw a belligerent tantrum if you challenge claims. Then they will invariably try to shame you for questioning them. Go on, try it!

The modality church

What does it take to create a modality church?

Rename the basic reflexes using your own invented terminology. Make it sound “revolutionary”.

Present your modality as if it were beyondthe science and/or keep your methods very secret. The secrets will only be revealed after your students have taken all the modules of your modality. Be sure they never actually understand the explanations of how you say it works. Make them believe this is because they will never fully grasp the enormity of your therapeutic holy grail.

Use buzzwords to create an impression you’re the modality master. Print many branded materials further affirming you as master.

Of course it’s perfectly fine to do this and I’ve taken a couple of classes that sound like they were pulled from the above grid. I even enjoyed them and learned lots of useful tidbits. Labels help us categorize approaches. However, realize trademarks significantly help in charging heaps more for a course and creating a cult following! Remember: you can trademark a name (that’s fine) but you cannot trademark any sort of touch. If so, sue me!

The modality church guru

I like to make up names for my therapeutic hand jives, too. The difference is I wouldn’t call a manual application my unique invention nor claim the rights to how you, as a student, should reference it. But many will try to do exactly that. When the creator of a modality church assumes the grandiose personality of an infallible know-it-all-touch-inventor (instead of someone you invest in to share useful chunks of actionable information with clarity), you have yourself a modality church guru.

Unfortunately, there is no shortage of useless information and word confetti. For example, consider obvious nonsense like astrology massage that is being peddled as valid continuing education for our healthcare profession (barf, don’t get me started). It’s fine as a hobby, but a laughable idea in a professional practice. I can’t list examples of a specific modality church because several “gurus” have literally resorted to bullying and suing people who debunk their claims or leak their “secrets”. I ain’t got time for dat.

Buyer beware

I write this in the hopes MT professionals become more selective about the classes and concepts they invest in. That’s right: CONCEPTS. I wasn’t always so skeptically discerning and have flushed plenty of money down the toilet on bogus classes. So, before plunking down your hard earned dollars on a CE course, I encourage you to dig into the underlying concepts the instructor offers in relation to that modality. Manual therapy techniques are not new anymore. So how are they presenting the concepts of their application? As theory or fact? As gospel or as an interesting perspective? Is it plausible? Ask for the research, then go a step further and research their research.

This-is-how-I-like-to-do-it-ies

It would thrill me if somehow the term modalities could be changed to this-is-how-I-like-to-do-it-ies, becausethat is basically what they are. It is much more accurate. They’re just how a particular instructor offers approaches, and those approaches should be based on solid science (we would think). My OPEN Bodywork class is basically about how I like to work it and why, based on sound science and years of reasoning.

Modalities are not to be confused with specializations, like oncology massage or chronic pain relief. Nor should they be confused with traditional systemized approaches like Nuad Bo Rarn/Thai massage or Shiatsu, whose foundations are based in spiritual and religious philosophies (ex., Thai massage has its roots in Buddhism and Shiatsu is based on the Chinese system of acupressure which is founded on Confucianism, but neither are based on physiology). Having an appreciation of the philosophy of a traditional approach is wonderful and beautiful, but philosophies are not the fundamentals. They are merely intangible beliefs that cannot be substituted for a very tangible understanding of physiology. Beliefs vary widely and often on any given day. Human physiology does not. It’s the only constant we can trust in our work. The rest is just personal adornment.

Conclusion

Modalities are not to be confused with the underlying concepts of how their applications may work. It is important to understand the difference. For example, I can petrissage a trapezius and offer 2 explanations:

I am squeezing energy out of the meridians found in that muscle and also stretching the fascia that reaches into their lower back. This works by combining an ancient philosophy with a modern theory. You have to learn it the way I tell you. I’m actually the only one who’s ever figured out how to move my hands in a way that effects both meridians and fascia. You can learn how to do this by taking my FascioMeridian™ Release class (feel free to steal that name, it’s not really trademarked, yet, haha).

I highlight theories according to current research that can be applied to any modality. I prioritize creating an environment of trust by honoring an individual’s needs and requests. Manual applications work because favorable signals are registered by nerve endings then processed by the brain. Safe, skilled touch feels really good and this in turn communicates a relaxation response to the whole body. I share my favorite manual approaches to accomplish this and you are free to use them as you like.

So, here is where I leave you. How will you invest your time and money in future education? Wherever it is, may you invest in yourself with eyes wide open 🙂

This is a fun picture post of the AMTA 2017 School Summit which took place at the Westin Boston Waterfront Hotel on February 23-24, 2017. It was a blast! My only regret is not getting more pictures of all the fantastic educators I got to mingle with.

Day 1: Here’s the first photo with my road trip buddy, Carla Gaskins-Nathan of Rooted Bodywork. We went to the summit as representatives of the PCOM-NY campus.

Group shot! Let’s play a version of Where’s Waldo?, but instead of trying to find Waldo, see if you can find me… then Carla.

Photo credit to AMTA

Later that day, the AMTA treated us to a comedy show at Laugh Boston. Here is a photo with a couple of the comedians who performed. Their sets were hilarious! I think stand-up comedy is the ultimate performing art and requires a great deal of bravery and confidence. They were awesome. And tall.

Day 2: Here I am having a fan girl moment with Susan Salvo of Massage Passport and Whitney Lowe of the Academy of Clinical Massage. These 2 have authored the textbooks I learned from! The coolest thing about them is they continue growing and innovating as educators. I want to be like them when I grow up 🙂

The next photos are double-selfies with 2 incredible and inspiring educators. Brent Jackson, is the academic program manager of a unique and impressive hospital based massage therapy program in South Carolina (the first of its kind!) and Jill Berkana, is the founder and owner of The Berkana Institute of Massage Therapy in Denver, CO. If I had to do it all over again, I would love to learn at both of these schools. These 2 are on fire and are producing phenomenal manual therapists. They just care so much and are excellent at what they do.

Selfie by Jill Berkanaselfie by yours truly 😉

Here is Tim Herbert of the Trail Guide Series we all know and love and have dog-eared many pages of. This guy gives THE BEST bear hugs!

And lastly, here is one more photo with Carla and Susan Salvo, for the road. They are both ridiculously photogenic.

Massage therapy can go down in the books as a healing art, but all art is healing on some level. Be it physical, psychological, or emotional, or all of the above. Art is creative, intuitive, and dynamic. Music is art. Writing is art. Dancing is art. Psychology is an art. Sculpting is art. Surgery is art.

As massage therapists we are artists who may be catalysts for some sort of processes via touch, but we are not healers. To assume the title of healer places an unrealistic burden on a practitioner and robs the client of realizing their own true innate ability. It also lends to a ludicrous exaggeration of our role by claiming victory over a resolution that isn’t ours.

Who is the healer?

Our clients are the only healers in the room. Just because we happen to be present at the time, does not make us the conductors who orchestrate their healing process in any way. It’s happening in spite of us and will continue to do so. However, being present gives us the honor of witnessing it on occasion. Our clients are the conductors. We are both the audience and ready instruments. But our instrument does nothing unless the conductor raises the baton of consent and allows us to behold their musical composition. A place in their orchestra is not guaranteed. The show will still go on.

It’s easy to take credit for being at the right place at the right time and think someone was “healed” all because we performed a special technique, but it’s not exactly warranted. What about all the times it doesn’t happen so dramatically, if it happens at all? This isn’t to discredit the wins by any means, it’s to dismantle the idea that there is a healer outside of anyone’s own body. A win is still a win. However, healing is a complex phenomenon we have no business taking credit for, as tempting as it may be sometimes.

We are helpers.

When a client feels better after a session with me, I realize someone else could’ve been just as effective (there are many other qualified professionals on the planet). It could be the luck of the draw, but everything that went well with that client happened as result of them trusting me enough to allow a pure connection at that moment. That is the nature of the therapeutic relationship. Though there is nothing magical about that idea, it is profoundly meaningful and humbling. When you think about the delicate nature of our work, it is a privilege when a client chooses one of us to help them. We are helpers.

I admit, helper doesn’t sound as majestic or glamorous as healer, but that’s just the ego being nit-picky. For some reason, there are those who prefer the mental image of us as cloaked druids with glowing auras upon Crystal Mountain as opposed to just being regular-Joes who give someone a hand-up after a fall. Our job is to be like Joe. Druids are considered weird nowadays and incantations don’t actually work (we should at least agree on that much if you’re on this website), but it is genuinely cool and beneficial to lend a helping hand. That is what we do. I like to think we offer that very well.

I used to be mildly Type A-ish

I understand the earnest desire to try to “fix” something. Humans are wired to want to improve upon any kind of condition, internal or external. But when we find we can’t, it becomes very frustrating. This is where egos can get bruised and things get weird.

Healer-types can go in 2 extreme directions: the Type A of martyrdom or the Type Z of complete delusion, with non-binary degrees in between:

Type A: the martyr is prone to unhealthy self-punishment and will think something is broken when their “healing powers” don’t do anything extraordinary. This leads into the lonely abyss of sacrificial lamb-ness and the fantasy that client’s are somehow “draining” their precious energy reserves.Counter-transference much? Clean that up!

Type Z: the delusional guy goes so far as to absurdly attribute ailments to obscure past life karma and/or resort to victim-blaming the client when his “healing powers” fail to work. Often it’s to the tune of you’re just not believing in my special powers enough (yeah, probably because you’re a complete nut-job).

No joke. I’ve actually heard things like, “he completely healed me of my of my past life whatever and then my headaches were gone”. To which I say, that is a sweet illusion. You healed yourself by means of a belief. And that’s awesome! But it is you whoaccomplished that. Your “healer” only helped remind and convince you of your own healing capacity, somehow, at that moment. And that surely does take skill. Whatever that skill may be, however it may be applied, and the environment it is applied in is the art part. We have helping skills.

Vague truth

Certain arts will appeal-to-or-actually-help certain people often, sometimes, or not at all and that may very well be attributed solely to belief. It is indeed rewarding when someone believes in you enough to trust you with their discomfort and understand you will do your best to help them. No matter what the scenario, trust is sacred. I call that a humble-win-win.

It’s not just semantics, it’s just annoying.

Paul Ingraham of PainScience.com addresses this exact point here and coins the term healer syndrome. He writes about it with such pointed accuracy that anyone, even self-proclaimed healers, would have a hard time denying it.

I know a massage therapist here in Vancouver who actually refers to herself as a “healer” on a regular basis. She seems to go out of her way to use the word, looking for excuses to mention that she’s a healer.

Ick.

It’s arrogant and distasteful, obviously. It’s an absurd conceit, incompatible with competence and professionalism. Humility is an essential ingredient in health care: if you don’t have it, it’s almost impossible to do a good job…

When therapists wear the healer identity on their sleeve, it makes them easy to avoid! Unfortunately, not all of them do. Acute healer syndrome is just the tip of an iceberg of less obvious ego problems among freelance therapists. For every therapist who actually uses the word “healer,” there are a dozen who have the attitude without being foolish enough to put it right on their business card.” -Paul Ingraham

When I was younger, I was sold on the idea I could be a healer and consequently believed I was after completing massage therapy school. I mean, who wouldn’t want the ability to miraculously heal someone else? There were so many classes and CEUs selling healing with YOU-as-healer, and yes of course I’d like to do that, sign-me-up. It was new and exciting. But professional maturity and common sense set in. I discovered this is a realm where helping someone relieve a back ache, walk a little straighter, or rehab a sprained ankle was considered a “healing” by many. Bonus if that ankle was also sprained in a past life! Please.

The idea may be born from a good place, but invariably the ego gremlin gets fed and it turns into a case of healer syndrome. That holier-than-thou mentality gets in the way of a client’s true healing by blocking their access to a deeper understanding of themselves and their sovereignty. Who would ever want to do that? Oh, a “healer” would.

The truth is the whole “healer” bit is just marketing. It is a term and concept that appeals to the ego. And everyone’s ego loves a good stroking. Oh, look what I did!(um….. this time… sorta? errr… ummm…). I have no issue with sales of safe and ethical techniques, just recognize what someone is trying to sell you. Check within to see if it’s marketed to feed your ego or if it can truly help your client. Hint: if it involves a “guru”, “master”, “proprietary technique” (may use the word “ancient”), or has the gate-keeper-secret-certification kind of model, it’s probably a marketing shtick 😉 Basically, all bodywork is “ancient”. Duh. I bought into enough of these gimmicks to smell them a mile away, and it’s not always because of patchouli, ifyaknowwhatimean. There are better places to invest your money.

Think about it

You know those amazing surgeons who perform hours-long life-saving heart transplants? And the nurses who tend to critically wounded vets on the battlefields? And seeing-eye dogs? And nuns that devote their lives nurturing children in orphanages? And the scientists that help extend millions of lives by improving upon medicine and technology? If I could crown anyone “healers” it would be them. Realize even they don’t address themselves that way and look at what they do. How dare anyone else? Please.

When a client tries to credit me by saying “thanks so much, you fixed my…..” or something like that, I must point out: “I couldn’t have done it without you, so thank YOU. Your body did the work”. We work together and they deserve all the credit. That’s the truth and it is our job to remind our clients and ourselves of it every chance we get.

Cupping gone wild. Nice try, Michael Phelps, but Gwenyth Paltrow did it first . And I tried cupping before it was cool. So there.

Before playing devil’s advocate, please know that I am ultimately pro-cupping (if it’s appropriate) and always have been. But I do not offer it as a service because I prefer working with my hands. I have received great cupping treatments which have brought me relief. I’ve also experienced painful cupping, which I did not enjoy at all and left me unnecessarily covered in purple circles without helping. And I’ve also had cupping which was meh and left me wishing someone would have just manually manipulated my tissues like I wanted. So does cupping work? Well, sometimes or maybe. And it depends. This is the only thing we can honestly say about cupping so far based on evidence and physiology. More on that later, but for now please have a look at just a tiny fraction of commentary which inspired this post:

What’s wrong with this picture? Um, EVERYTHING. The “bottom line” is LOTS of damage can occur, considering the bandwagon-ism of the other comments. Truth is we don’t know exactly why cupping appears to work and chances are many other modalities can work just as well, sans bruising. That’s fair.

Let’s be honest-er

Do I personally need evidence for everything I choose to practice? NO. Because there is not yet an answer for everything, but with a little legwork and critical thinking there is access to great working hypotheses. It is important to know the difference between a fact and a good guess. When whatever I’m doing is based on an educated guess, I clearly tell clients “I don’t know/not sure/as far as we know this could be how xyz works (or not), but I’m happy you feel better somehow”. This is being honest and clients respect that (for the record, I am guilty of having made many false claims before I knew better and was called out on them). Clients can google cupping and in 30 seconds find way more evidence against it than for it (this does not mean it does not help on some level- but the mechanisms by which it has claimed to work have been dismantled by Physiology 101 so we must move on to another hypothesis… be patient, we will get there). We are accountable for the explanations we choose to give, so let’s be honest-er.

Do I need evidence if I am going to make claims to the public about how, why, or if something works? Oh, hell yes. Otherwise, that is called making up stories and our profession needs to stop doing that if we want to move forward.

I’m all for continuing education and expanding treatment options that may work for somebody. What I’m not for is people running out and hurting their clients because the dangers of cupping are being under-touted and lost in dazzling paparazzi camera flashes. I’m also not for people spreading misinformation about when and how it may or may not work (that is in essence, lying). And lastly, I’m not for the hubris that comes along when people under-tout and misinform and are not even aware that they may be unaware (aka the Dunning-Kruger effect). Yet all of these things have happened overnight with the Phelping of cupping and it’s a little disconcerting.

Guess what? Michael Phelps was winning bucket loads of gold medals before he ever did cupping. So, maybe he’s just a great athlete and maybe cupping isn’t magic? What about all the other gold medalists who don’t employ cupping and still excel in their sports? Just pointing out the holes in this logic. With this same thinking we should also see the use of recreational cannabis explode as well; Michael Phelps smokes lots of pot, therefore, mega bong hits must be the reason behind his record-breaking gold medal collection. Does that mean we now have to become weed dealers in order to help our clients? In this New York Times article (it is one people have been citing to support the purported miraculous jene saisquoi of cupping), even Phelps’s personal trainer, Keenan Robinson, is quoted saying, “It’s just another recovery modality. There’s nothing really particularly special about it”. So let’s all slow the roll and step back a bit for the sake of ethical and safe practices.

The newest ancient sensation sweeping the nation

Literally OVERNIGHT, the price of cupping sets doubled on Amazon. Enrollment in cupping continuing ed courses has skyrocketed and so has the amount of MTs and others who now offer cupping out of the clear blue sky. Cupping has been featured front and center on every news website and even the ABMP is seizing the opportunity to wrangle up some extra CE cup-sized dollars. Laymen are cupping themselves until they implode into self-inflicted vacuums. It’s raining cups, hallelujah. Sure, this can be all good in the right hands. But what is not good are the false claims and careless practices that will burst in the Cupping Bubble of 2016. Think sub-prime mortgages, but with ancient healing cups. We all know how that ended.

Just like massage can be harmful, cupping can be harmful. Which is why I’m writing this. Our profession is full of hubris and skewed “truths” and serious massage professionals know this all too well (review the screenshot I posted up top and that’s just the tip of the iceberg). It is the sole reason why our profession is not where it could and should be. Sure, cupping may help some people sometimes, but many people have also been injured (I dare you to Google “dangers of improper cupping”). Professionals hopping on the cupping bandwagon like, “CUPPING IS THE MOST AMAZING THING EVERRRR. CUPPING WILL CURE YOU OF EVERYTHING!! CUPPINGCUPPINGCUPPING! I WILL NEVER NEED TO USE MY HANDS AGAIN, BWAHAHAHA!”, quite frankly, scare me.

Seriously, everybody chill. Cupping has been around almost as long as, well, cups. Why is it like a thing all of a sudden? Because the media has propelled the public into demanding it whether it may or may not be effective for them. And there are irresponsible practitioners beginning to do the same at an alarming rate. It’s ironic to witness an ancient practice become a modern fad that loses all respect for the art itself and laughs at science because Michael Phelps. It is CAM sensationalism at its finest. But at what cost?

Pros and cons

What do you want first? The good news or bad news? Let’s do bad first so we can end this on a positive note. Please allow me to highlight only a couple of the epic fails in cupping therapy (and there are many more which go unreported):

“Oh, but that’s fire cupping“, you say. “I would never do that”, you say. “I use the suction-cup-pump thingies which are totes safe”. Well, then allow me to show you Exhibit B: The Horrors of Improper Massage Therapy (all about suction cupping gone wrong).

If that’s not enough to convince you this can be dangerous in the wrong hands, well, you are likely one of those people that scare me. Yes, driving is statistically the safest mode of transportation, however, avoidable accidents happen every day; most often because people: A) are not paying attention, B) do not ever think it could possibly happen to them so they fail to practice basic safety precautions, or C) a combination of both A and B. If someone is not capable of acknowledging the dangers of cupping, they are in no position to proclaim its benefits. And if everyone starts pushing this like it’s the best new ice cream flavor in town, we are in big trouble.

Physiology 101

Claim: A cupping mark is not a bruise.

Truth: Indeed it is. I agree, “cupping mark” sounds much more endearing than bruise and Sweet n’ Low sounds cuter than aspartame, but under a microscope it is the same thing. Tocopheryl acetate= Vitamin E. Every research paper ever published iterates the marks are circular ecchymosis (you know what that means). Broken capillaries are exactly that: broken/disrupted capillaries. This is not to negate that cupping induced ecchymosis may have therapeutic value, but rather any such value has not been clearly defined under the existing paradigm of cupping. Also, the bruising may very well be entirely unnecessary in order to achieve results. Imagine that. It is both a cupping mark and a bruise and to deny that is to deny climate change. “But in Chinese medicine it is not a bruise, it is caused by stagnation”, you say? “It is sha“, you say? As far as I recall, actual stagnation leads to necrosis and if we aren’t referencing the same medical dictionary, this discussion will go nowhere. Call it sha or whatever you want, a bruise by any other name is still a bruise.

Claim: Cupping does not cause damage.

Truth: If that is what you believe, kindly put the cups down, walk away slowly, and never use them on anyone ever again. Please. If cupping causes capillary damage, that is by definition damage. The extent of the damage is another story, but a blanket statement of ignorance regarding the potential dangers is reason to worry. If I went for a cupping treatment and the therapist did not acknowledge this, I would not allow them to perform the treatment on me. Period. Surgeons acknowledge all the risks of a procedure before performing it. Cupping is not above a surgical procedure. We’ve already discussed the serious damages that can occur.

Claim: Cupping does not hurt.

Truth: Say whut? More accurately, cupping should not hurt. But it sure can! It’s hurt me on occasion. If someone says it hurts them, please believe them and pop that thing off. Remember do no harm? Yeah. THAT.

Claim: Cupping removes toxins.

Truth: LOL. I could leave it at lol, but that’s not productive. First of all, define the “toxins”. I’ll wait… mercury? arsenic? lead? cholera? some kind of bacteria? a skin-eating amoeba? According to the laws of the universe, there are only 2 ways actual toxins leave the human body; either poo-poo or pee-pee. That’s it. If they are able to be leeched out of someone’s skin with vacuum cups, your client is an alien species and not human. Or a frog. Maybe they’re a frog. Don’t take my word for it, read this.

Claim: Cupping improves circulation and lymphatic function.

Truth: Whoa, I’m confused. If cupping creates a bruise, sorry, I mean “cupping mark”, which is a disruption in local circulation- technically sucking blood out of the circulatory system- how is this an improvement? When I bump into a table and bruise my thigh (which happens more often than I’d like because I’m a clutz), I don’t think “Look at the improved circulation!” I understand it is minor internal bleeding, which is hardly an improvement. And as for lymphatic function, HOW? Yes, I read the explanation “suction pulls plasma and red blood cells into the tissues and up through the layers and the lymphatic system towards the surface” and I don’t understand. Blood doesn’t get sucked through the lymphatic system. I looked for evidence for this mechanism online (because this would be easily testable in a lab) and there is zero to affirm it. ZERO. Therefore, it is a false claim. I could also claim cupping helps my hair grow faster by suctioning my follicles (even though my hair grows anyway). Makes just as much sense.

If we want to give someone an accurate, ethical explanation about cupping and how it may help them, the information in this link is pretty much the only wording that does the justice. To that you may add, “let’s try and see if it helps” and proceed with care and humility. As MTs, we have to do better than just repeating inaccuracies. It is our responsibility to be clear. We can help people without making up stories and we should give our clients more credit than that. Cupping is not magic, unless of course you somehow manage to pull rabbits out of cups after a treatment, TA-DA! Then it’s magic 😉

The positives and the hope

Cupping also stimulates the mechanosensitive Aβ fibers which reduce nociceptive input. More intense stimulation activates the C and Aδ fibers in the affected areas, thereby raising the inhibitory receptive fields of cortically projecting and provoking diffuse noxious inhibitory controls. In addition, cupping probably strongly impacts relaxation and may serve as a social, comforting interaction. Further investigations of these mechanisms of action are necessary.” -Rozenfeld 2016

Now, this is a potential positive effect of cupping worth exploring! Skin deformation is something cupping has in common with many other effective modalites such as Graston technique (the Western version of GuaSha) and manual therapy. The nerve receptors which register mechanical pressure (in this case, created by the cups pulling the skin up-and-in via the vacuum effect) are stimulated in a way that inhibits nociceptive signals the brain may interpret as pain or dysfunction. Hmmmm…. see where this is going? Don’t the potential effects of cupping on the nervous system which regulates all other systems, make so much more sense than promoting unfounded claims? Could that be why people feel better afterwards? Do clients really need to be bruised for cupping to be effective?

I will leave it at that hypothesis and I do not have the answers to any of those last questions, but it is food for thought. To give credit where credit is due, I stumbled upon this better notion by reading something written by Jason Erickson (I will update this with a link whenever I find it again, but for now the reference is lost in cyberspace).

Conclusion

I like cupping! Many people do for their own reasons and there are so many skilled practitioners. What I do not like are false claims or clients being misinformed. Perform cupping with care, know its limits and potential dangers, and remember it’s ok to say “We don’t know exactly how or when this works, but if you want to try it out I will do my best. Let me know how you feel”. Is that so bad after all?